Cirrhosis

In the United States, the most common causes of cirrhosis include heavy alcohol consumption and chronic hepatitis C. Due to rising rates of obesity, the incidence of nonalcoholic fatty liver disease is also increasing. Many people with cirrhosis have more than one cause of liver damage.

Causes of cirrhosis (from most common to less common) include:

• Chronic hepatitis C
• Alcohol-related liver disease
• Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)
• Chronic hepatitis B
• Autoimmune hepatitis
• Diseases that damage, destroy, or block the bile ducts
• Inherited diseases that affect the liver
• Hepatitis D and E (rare viral infections)
• Drug reactions, toxins, and infections

The early stages of cirrhosis are typically asymptomatic. Symptoms typically begin as the disease progresses. They may include:

• Weakness
• Fatigue
• Loss of appetite
• Weight loss
• Nausea/vomiting
• Abdominal pain and bloating when fluids accumulate in the abdomen
• Itching
• Spider-like blood vessels on the skin

In the later stages of the disease, complications may arise, such as:

• Portal hypertension, or high blood pressure in the portal vein, which carries blood from the stomach, intestines, spleen, gallbladder, and pancreas to the liver
• Fluid buildup in the feet, ankles, or legs (edema) or in the abdomen (ascites)
• Jaundice (yellowing of the skin and whites of eyes)
• Bruising and bleeding
• Enlarged blood vessels in the esophagus (esophageal varices) and/or stomach (gastropathy) caused by portal hypertension
• Enlarged spleen (splenomegaly) caused by portal hypertension and resulting in low platelet count
• Gallstones
• Sensitivity to medications
• Buildup of toxins in the brain (hepatic encephalopathy)
• Insulin resistance and type 2 diabetes
• Liver cancer
• Immune system dysfunction
• Kidney and lung failure

Cirrhosis is typically diagnosed based upon symptoms, history of alcohol use, and obesity. The doctor will confirm a diagnosis of cirrhosis after reviewing your medical history and performing a physical examination, blood tests, imaging, and/or a liver biopsy.

Blood tests check for abnormal liver enzyme levels or abnormal numbers of blood cells or platelets. After diagnosis, blood tests can help determine the cause of cirrhosis, such as hepatitis B or C.

Diagnostic imaging such as ultrasound, CT scan, or MRI can detect an enlarged liver or spleen, reduced blood flow, gastric varices, or ascites (fluid in the abdomen).

A liver biopsy may be performed to help determine the severity, extent, and cause of liver damage.

Treatment can help cirrhosis, but the disease can’t be cured. The goal is to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. You may need to be hospitalized if you have severe liver damage.

Treatment depends on the cause and extent of liver damage. If alcohol is the cause, you should stop drinking and seek help for alcohol dependency, if necessary. If obesity is causing your cirrhosis, you should lose weight. If hepatitis B or C is the cause, your doctor will prescribe medication to control the condition. Your doctor will also treat other causes of cirrhosis, as well as complications.

For those with liver failure, a liver transplant may be your only treatment option. Doctors use the model for end-stage liver disease (MELD) score to measure the severity of cirrhosis and determine whether a person is eligible for liver transplantation.

The MELD score, which predicts the 90-day survival of people with advanced cirrhosis, is based on three blood tests:

• International normalized ratio (INR), which tests the clotting tendency of blood
• Bilirubin, which tests the amount of bile pigment in the blood
• Creatinine, which tests kidney function

MELD scores usually range between 6 and 40, with a score of 6 indicating the best likelihood of 90-day survival.